Kolhapur Cancer Centre Aiming for Perfection at Grass Root Level, Spreading Care to Those in Need!

There is a big need for more comprehensive cancer centres in tier 3 cities in India. These small cities are the most accessible to the majority of the rural population of India. Most of these patients are economically compromised and thus cannot manage treatment options in metropolitan cities. Kolhapur Cancer Centre was started with the philosophy of "paying back to society" and serving these needy patients in rural India.

Minimally Invasive Esophagectomy in Semi-Prone Position (Pawar Technique): Technical Aspects and Outcome in 224 Patients.

Background and Objectives There are two patient positions described for minimally invasive esophagectomy (MIE) for esophageal cancer, viz., left lateral and prone positions. To retain the benefits and overcome the disadvantages of these positions, a semi-prone position was developed by us. Our objective was to analyze the feasibility of performing MIE in this position. Materials and Methods A retrospective review of patients who underwent MIE at our center from January 2007 to December 2017 was done. A semi-prone position is a left lateral position with an anterior inclination of 45 degrees. Intraoperative parameters including conversion rate, immediate postoperative outcomes, and long-term oncological outcomes were analyzed. Statistical Analysis Statistical Package for the Social Sciences version 19 (IBM SPSS, IBM Corp., Armonk, New York, United States) was utilized for analysis. Survival analysis was done using Kaplan-Meier graph. Quantitative data were described as mean or median with standard deviation, and qualitative data were described as frequency distribution tables. Results Consecutive 224 patients with good performance status were included. After excluding those who required conversion (14 [6.6%]), 210 patients were further analyzed. Median age was 60 years (range: 27-80 years). Neoadjuvant treatment recipients were 160 (76%) patients. Most common presentation was squamous cell carcinoma (146 [70%]) of lower third esophagus (140 [67%]) of stage III (126 [60%]). Median blood loss for thoracoscopic dissection and for total operation was 101.5 mL (range: 30-180 mL) and 286 mL (range: 93-480 mL), respectively. Median operative time for thoracoscopic dissection alone was 67 minutes (range: 34-98 minutes) and for entire procedure was 215 minutes (range: 162-268 minutes). There was no intraoperative mortality. Median 16 lymph nodes were dissected (range: 5-32). Postoperative complication rate and mortality was 50% and 3.3%, respectively. Disease-free interval was 18 months (range: 3-108 months) and overall survival was 22 months (range: 6-108 months). Conclusion MIE with mediastinal lymphadenectomy in a semi-prone position is feasible, convenient, oncologically safe, which can combine the benefits of the two conventional approaches. Further prospective and comparative studies are required to support our findings.

Preoperative Chemoradiation in Locally-Advanced Resectable Carcinoma of the Esophagus in a Single Rural Cancer Hospital in Western India.

Background The current standard of care for the treatment of surgically resectable carcinoma of the esophagus is preoperative chemoradiation followed by surgery. There is strong evidence that this trimodality approach improves survival as compared with surgery alone. Objective The objective of this study is to determine the feasibility of this approach in a rural cancer institute in western India. Materials and Methods The data of all the 157 consecutively treated patients with locally-advanced carcinoma of the esophagus from March 2013 to March 2017 who were started on preoperative chemoradiation were analyzed retrospectively. Results Of the 157 patients who were started on preoperative chemoradiation, 68 patients underwent surgery. There are various practical reasons for not undergoing the definitive surgery, with the important being the socioeconomic support to the patients during the course of treatment. Conclusion This study gave us insight into the strategic selection of patients for the trimodality approach as well as the need for continuous socioeconomic support throughout the treatment course.

Retrospective analysis of patients with carcinoma cervix in a rural/semi-urban setting in Western India.

OBJECTIVES: To compare the presentation of cervical cancer and the treatment modalities received by the patients at a semi-urban/rural area of Western India with that of published literature from urban centers. MATERIALS AND METHODS: We conducted a retrospective analysis of patients with cervical cancer who presented at a semi-urban/rural cancer center between 2010 and 2013. A total of 141 patients with the median age of 51 years (25-81) were studied. The demographic and clinical variables included age, annual family income, profession, comorbidities, baseline hemoglobin, prior screening, clinical stage, treatment administered, and complications. The pathological variables included tumor type and grade. RESULTS: In our study, all patients presented with vaginal bleeding. Majority of the patients (51 patients, 37.7%) had Stage 3B disease. Since majority presented at later stages (Stage 3B), chemotherapy-radiotherapy was the most common treatment modality used in our population. On histopathology, 127 patients (90%) had squamous cell carcinoma while 14 patients (10%) had adenocarcinoma. In 96 patients (68%), the tumor grade was not known while it was a high, intermediate, and low grade in 6 (4%), 18 (13%), and 21 (15%) patients, respectively. The follow-up data of our study were not adequate; hence, the long-term survival results could not be presented. CONCLUSION: Patients in rural India setting present at later stages which could be improved by creating awareness, improving their personal hygiene, and adequate screening.

Evaluation of ER, PR and HER-2 receptor expression in breast cancer patients presenting to a semi urban cancer centre in Western India.

BACKGROUND: Hormone receptor expression has been reported to be low in breast cancer patients from developing countries. The pattern of receptor expression from urban and rural areas is not well studied. MATERIALS AND METHODS: This is a retrospective analysis of 206 consecutive breast cancer patients presenting to a semi urban cancer centre from 2009-2010. The demographic and clinical variables included age, residential area (rural, semi urban, or urban), menopausal status, and clinical stage. The pathological variables included tumor type, the presence of ductal carcinoma in situ, lymphovascular invasion, and expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) receptors by immunohistochemical (IHC) analysis. RESULTS: The majority of patients were postmenopausal with the median age of 50 years. Invasive ductal carcinoma was the most common subtype (94%). The ER status was available in 101 (49.3%), PR in 99 (48.0%), and HER2 in 82 (39.8%) cases. In patients in whom this data were available, ER was positive in 44.6%, PR in 40.4%, and HER2 in 34.2%. Out of the 82 patients in whom data on all three receptors were available, 34.1% patients had triple negative tumors. Analysis of our data showed a trend toward increasing ER and PR expression with age but this was not statistically significant. The average age of menopause was between 40-50 years of age. CONCLUSION: This report is an important documentation of the pathological characteristics in a predominantly rural/semi urban population of Indian breast cancer patients. Further studies from other centers with a similar background are required to confirm these results.